A Qualitative Study of Medical Students' Perspectives on Distance Learning During COVID-19.

Introduction: With the Coronavirus disease 2019 [COVID-19] pandemic, changes were undertaken out of necessity to allow medical students to continue their education. The aim of this study is to create key themes for educators to consider when implementing distance learning strategies into the curriculum based on 2nd year graduate entry medical students experience of learning and engagement with the use of distance learning during the COVID-19 pandemic. Materials and Methods: A qualitative study with a phenomenological methodology was set within a constructivist paradigm. A volunteer sampling strategy was used to recruit participants. Nine semi-structured, audio-recorded interviews were undertaken and transcribed verbatim. A thematic analysis was undertaken of the transcripts using the Braun and Clarke framework with an open-coded approach. Results: Exploration of the student experience generated an understanding of the learning process. The concept of adaptability emerged based on the themes of technology, environment, study skills and human interaction. Discussion: Necessary changes to the formal curriculum affected medical students learning and experience that demanded adaptability. The 'new normal' generated a context within which students were communicating and interacting in ways creating individual challenges for students and educators. Conclusion: With the advancements in information, communication and technology, distance learning is likely to be further incorporated in undergraduate training long term. Its position should be one that is harmonious within the wider educational realm that engages and meets the needs of the students. The rich understanding exposes adaptations and considerations for educators to improve the student experience.

Experience of a specialist emergency bariatric surgical service.

BACKGROUND: Bariatric surgery is associated with late and procedure-specific acute surgical complications. There is very little evidence available regarding the volume, nature, and outcomes of acute surgical admissions directly stemming from bariatric surgery. Centralization of bariatric elective services in the United Kingdom may have an adverse impact on the ability of local services to manage such unpredictable complications. To address this potential problem, we set up a comprehensive and specialist emergency bariatric service. OBJECTIVES: The aim of this study was to quantify and characterize the workload of a specialist emergency surgical bariatric service. SETTING: University National Health Service hospital. METHODS: Over 2 years, we prospectively collected data on demographic characteristics, management, and outcomes of all acute surgical admissions related directly to previous bariatric surgery. RESULTS: Between December 2011 and November 2013, 69 patients had 71 emergency admissions due to a surgical emergency directly related to previous bariatric surgery. Thirty-seven (54%) had undergone primary bariatric surgery at our institution, 13 (19%) at a different National Health Service hospital, 16 (23%) at private U.K. hospitals, and 3 (4%) at private overseas hospitals. Forty-four endoscopic or surgical interventions were required, of which 17 (39%) were performed on nights or weekends and within 12 hours of admission. Of 27 operations, 25 (93%) were completed laparoscopically. Median length of stay was 2 days, there were no mortalities, and there was 1 readmission within 30 days. CONCLUSIONS: There is a significant volume of late bariatric surgical emergencies, many requiring urgent intervention. These may be effectively managed by a specialist bariatric service.

Enteral immunonutrition versus standard enteral nutrition for patients undergoing oesophagogastric resection for cancer.

A best evidence topic in surgery was written according to a structured protocol. The question addressed was "In cancer patients undergoing oesophageal or gastric resection for cancer and requiring postoperative nutritional support, does enteral immunonutrition confer additional clinical benefits as compared to standard enteral nutrition? Two hundred and fifty-eight papers were identified by a search of the MEDLINE and EMBASE databases, of which six randomized controlled trials represented the best evidence to answer this clinical question. The authors, journal, date and country of publication, patient group, study group, relevant outcomes and results of these papers were tabulated. All six of these randomised controlled trials compared the clinical benefits of standard enteral nutrition with those of enteral nutrition supplemented with a variety of immune-modulating substances. The studies failed to demonstrate consistent differences in patients' postoperative clinical course, complications, length of hospital stay and inflammatory marker levels. Hence although there is reasonable evidence to suggest that immunonutrition improves humoral immunity as opposed to cellular immunity, this improvement does not result in reductions in infection rates or reduced hospital stay. There is currently not enough evidence to recommend routine immunonutrition in all patients undergoing oesophageal or gastric resection for cancer.